‘Mentally & physically debilitating’ — PCOS on the rise in India, but new treatments bring women hope

Studies show about one in 10 women in India may be suffering from PCOS, which comes with a range of symptoms and risk factors. New treatments could improve outlook, doctors say.

Illustration for representation | Prajna Ghosh | ThePrint

New Delhi: Seventeen-year-old Shraddha, a Class 12 student in a top Delhi school, was already grappling with the stress of exams, bodily changes, and the complex dynamics of teenage relationships. So, when she developed a long list of “debilitating” and inexplicable mental and physical symptoms last year, she felt crushed.

“I noticed coarse hair growing on my face and other body parts, my menstrual cycle went haywire, I started putting on weight rapidly without any dramatic changes in my eating pattern, and would have horrible bouts of mood swings,” Shraddha says, asking that her last name not be published.

“I would cry for hours without any obvious reason and be calm at other times — it is hard to explain how I felt,” she adds.

After a few months, Shraddha was finally diagnosed with polycystic ovary syndrome (PCOS), a hormonal disorder that affects women of reproductive age and is associated with a range of symptoms.

The exact root causes of the condition are not known but it arises when the ovaries produce an excess of androgens, or male sex hormones, typically found in smaller amounts in women.

Shraddha is not alone in her suffering. Doctors who spoke to ThePrint claimed that the prevalence of PCOS in India seems to be increasing.

“The incidence of PCOS is 10 percent or more in India and it is growing, depending on which criteria are used,” said Dr Mahesh Chavan, consultant endocrinologist with the Apollo Hospitals in Navi Mumbai.

A growing health issue in India

Dr Chavan’s estimate of the prevalence of PCOS reflects the findings of a 2022 meta-analysis of 11 systemic reviews on the condition. This analysis, published in the open-access Cureus Journal of Medical Science, found that the prevalence of PCOS is 11.34 percent in India.

This estimate accounts for the presence of two out of three symptoms falling under the Rotterdam Criteria, the most commonly used diagnostic tool for PCOS — oligo‐anovulation (eight or fewer periods every year), hyperandrogenism (excess production of male hormones), and polycystic ovaries (small sacs of fluids in ovaries).

The number of women seeking medical help for PCOS symptoms is increasing, according to Dr Gayatri Deshpande, a senior consultant in obstetrics and gynaecology at Max Nanavati Super-speciality Hospital in Mumbai.

“Approximately 25 to 30 percent of my patients are diagnosed with PCOS. On average, I see at least three to four new women with complaints of the condition every day,” she said.

“The condition is common among women of reproductive age and most of them complain of irregular periods, excessive hair growth, acne, and weight gain or difficulty losing weight,” Deshpande added. “Some women also experience thinning hair, dark patches on the skin, and the development of skin tags.”

Deshpande pointed out that severity of PCOS varies significantly from patient to patient.

At one end of the spectrum, there may be women who present mild irregularities in their menstrual cycles, perhaps every 45-60 days, while at the other extreme, there are patients who have extended menstrual intervals of up to six months to a year, she said. Commonly associated symptoms can also vary in intensity, including acne and facial hair growth.

If left unmanaged, PCOS can lead to serious health complications such as type 2 diabetes, cardiovascular disease, and endometrial cancer. It may also affect fertility and increase the risk of miscarriage.

This was the case for 31-year-old Bhavya, a Mumbai resident who experienced PCOS-related infertility.

“My husband and I were desperately trying to plan a family but PCOS made it so difficult for us,” she said.

“We finally had to opt for in-vitro fertilisation (IVF) to have a baby and the process was mentally, physically and financially exhausting,” she said.

While the terms PCOS and PCOD (polycystic ovarian disease) are sometimes used interchangeably, PCOS is a more complex and severe endocrine disorder. PCOD — in which ovaries start releasing immature eggs that lead to hormonal imbalances — is often addressed by lifestyle changes, but PCOS usually requires the use of external hormones for effective management.

What are the risk factors?

The apparent increase in the incidence of PCOS could be linked to lifestyle factors such as sedentary behaviour, unhealthy dietary patterns, and stress, said several medical experts who spoke to ThePrint, including Chavan.

Indeed, such factors are likely to be the main culprit, according to Dr Duru Shah, founder-president of the PCOS Society of India, and director, Gynaecworld – The Center for Women’s Health and Fertility in Mumbai.

“Only 5-10 percent cases of PCOS are genetically transmitted from mother to her daughter,” Shah said. “The majority of the disease is due to epigenetic changes such as imbalance of hormones, which have not been corrected, exposure to various environmental pollutants, and obesity.”

Shah pointed out that nearly 80 percent of PCOS patients are either overweight or have obesity. However, Deshpande said that she believed the prevalence of obesity in PCOS patients to be closer to 50 per cent. In the international literature, too, estimates of obesity prevalence seem to cover a similarly wide range.

Deshpande added that being overweight seemed to contribute to more severe symptoms in PCOS patients, especially in women with a Body Mass Index (BMI) exceeding 27.

Hormone imbalances and genetic predispositions are also major contributing factors to PCOD, according to Dr Bhagya Lakshmi S, a senior consultant obstetrician, gynaecologist, and laparoscopic surgeon at Yashoda Hospitals in Hyderabad.

Stress and PCOS 

Stress plays a role in disrupting hormone balances, potentially influencing the development of PCOS.

While the link between stress and PCOS is still being studied, some research suggests an association, including a 2018 study by Indian researchers published in the peer-reviewed Journal of Human Reproductive Sciences.

Additionally, women with PCOS may also have a higher risk of developing stress disorders.

Dr Trideep Choudhury, a consultant psychiatrist at Fortis Flt Lt Rajan Dhall Hospital in Delhi, emphasised the importance of addressing mental health issues in patients with PCOS.

“Patients with PCOS are sometimes referred to mental health professionals. Treating them requires multifaceted approaches,” he said.

“Incorporating mental health assessment into clinical evaluations and implementing interventions such as diet, exercise, cognitive-behavioural therapy, and lifestyle changes can be beneficial,” he explained.

Advances in treatments

Management of PCOS symptoms and correction of underlying hormonal imbalances are the main goals of treatment, according to Dr Rashmi Baliyan, a consultant obstetrician and gynaecologist at Primus Super Speciality Hospital in Delhi.

Traditional methods of treatment include adopting a balanced diet, engaging in regular exercise, and making lifestyle changes such as weight loss, she said. Depending on specific symptoms, medications may also be prescribed, including oral contraceptives, anti-androgens, and insulin sensitisers.

A patient’s age is also a factor in the treatment regimen prescribed to them, added Dr Parimala Devi, senior consultant, obstetrics & gynaecology, at Fortis hospital in Bengaluru.

She said that the main treatment options for PCOS in the young adolescent group include diet, exercise, and oral contraceptives.

“Women of childbearing age may be treated with oral cyclical hormones, along with exercises and diet adjustments,” she said. “It is important for women in their late 40s to be cautious as they may be at risk for diabetes. Seeking advice from an endocrinologist and considering antidiabetic medications may be important for this age group.”

According to Dr Bhagya Lakshmi S, while PCOS is not curable, the treatment goals focus on reducing clinical hyperandrogenism, managing menstrual irregularities, preventing endometrial hyperplasia (a condition where the uterus lining becomes too thick) and cancer, achieving ovulation for those seeking pregnancy, and addressing long-term metabolic issues.

First-line medical treatments for PCOS often involve combined low-dose hormonal pills due to their effectiveness in managing hyperandrogenism, regulating menstrual irregularities, and reducing the risk of endometrial cancer. Additionally, the common diabetes drug metformin can be prescribed to decrease insulin resistance.

In cases where hyperandrogenism persists despite hormonal pills, doctors may consider adding antiandrogens. For those pursuing pregnancy, ovulation induction can be achieved with medication such as clomiphene citrate, letrozole, and, more rarely, gonadotropins.

However, there are newer treatments available too, including in India.

Studies on newer glucose-lowering agents like glucagon-like peptide-1 receptor analogues (GLP-1RA), including drugs like exenatide and liraglutide, have shown promising results in the treatment of obese women with PCOS.

Dr Bhagya Laksmi S said that these agents have demonstrated better outcomes than metformin in terms of weight reduction, increased menstrual frequency, and improvement in hyperandrogenemia and metabolic issues.

The Hyderabad-based doctor also pointed towards the potential of selective SGLT-2 inhibitors such as empagliflozin and canagliflozin. These drugs help lower glucose levels through an insulin-independent mechanism. They also help reduce hyperinsulinism and improve insulin sensitivity.

Furthermore, newer drugs such as melatonin and lactoferrin have shown potential in improving ovulatory function in PCOS. With early detection and advancements in treatment, according to Bhagya Lakshmi S, the quality of life for most patients can be significantly enhanced.

That may be good news for patients like Shraddha.

(Edited by Asavari Singh)